Simply automating what we currently do will not fix the problem.Use AHEC for rural areasMedicaid paymentsCertification programNC HIE (e-prescribing, structured labs, clinical records, PH reporting)NC Community College systemMiddle mile connectivity – broadbandEvidence-based medicine, best practicesRural health strategy12. ROI, Patient centered; lower cost
Real time Televide – skype, facetimeStore & Forward Telehealth – image/data xfer to central server for later reviewIn-home messaging – central server upload/download questions to patient – responses via keypad linked to telephoneemail,Virtual Reality (wheelchair training)
PM&R = Physical Medicine & RehabAmp = AmputationPT/OT = Physical Therapy/Occupational Therapy
RCT = Randomized Control Trial
Reliability refers to the confidence we can place on the measuring instrument to give us the same numeric value when the measurement is repeated on the same object. Validity on the other hand means that our measuring instrument actually measures the property it is supposed to measure.
CCNC takes a lot of data from many different sources and delivers web reports
Health IT seminar review
Health IT Seminar Review CLIFF KAUFMAN
Focus on NC NC Strategy for HIT Steve Cline, DDS, MPH HIT Coordinator, NC DHHS Using Telehealth Technology for Rehabilitation Helen Hoenig MD, MPH Durham VA Med Ctr Duke University CCNC Informatics Center Annette DuBard, MD, MPH North Carolina Community Care Networks, Inc. NCB Prepared Steve Potenziani, PhD Executive Director, NCB-Prepared Collaborative
NC Strategy for HIT GOALS PROBLEMS Improved healthcare quality Paper is inefficient Better health outcomes Duplicate tests Individuals Medical errors Populations Lack of information Control costs Too much information Better engage health care Consumer engagement consumers Quality-Quality-Quality
The 12-Step Approach1. Admit we have a problem2. Must get clinical information into an electronic sharable format.3. Incentivize targeted providers to adopt EHRs and meaningful use4. Create a new standard for EHR vendors5. Build a mechanism for sharing health information electronically6. Make sure healthcare providers know how to use the new systems7. Make sure the network has the capacity for all these new users8. Make good use of the data (Data Analytics)9. Make good use of the technology to improve health10. Children as a priority11. Learn from the leaders12. Sustainability
Keys to Success EHR Adoption Consumer Engagement Change Leadership Strengthen the “Trust Fabric” of health info exchange GOOD USE OF THE DATA! And the Winner Is . . .• Whoever can figure out how to take the tsunami of new health data that is heading our way and turn it into actionable health information.• Whoever can help us move from surveillance and reaction to event prediction and prevention.
Telehealth Technology for Rehabilitation Public Health Problem It is difficult for persons with physical disability, particularly in remote areas, to access health care. High cost and burden of travel. Limited rehab specialists in remote areas. Clinicians have limited insight into how individual is functioning in home environment. What is Telehealth? Telehealth is comprised of diverse technologies that allow health care to be provided in situations where distance separates those receiving services from those providing services. Telehealth changes the location for providing health care services from the doctor’s office or hospital to the local clinic or the patient’s own home.
Telehealth – Rehab Clinical Trials Telerehabilitation for exercise & functional training: 4 RCTs with Televideo alone or with other Teletechnology. 4 different populations (geriatric gait disorder, post-stroke, ICU survivor, post-op orthopedic surgery). Non-inferiority in clinical outcomes compared to Standard PT. Better functional outcomes , performance-based & self report, compared to Usual Care (no PT). Equipment reliability and visual clarity a challenge in all studies
Teletechnology QI Study 3 types physical function tested Fine motor coordination: finger taps (front view) Gross motor coordination: gait (lateral view) Spatial relationship: cane height (front & lateral views) Reliability & validity determined 3 common Internet speeds (64, 384, 768 kps) In person (community standard) and slow motion videotape (gold standard) Internet bandwidth had a strong effect on validity and reliability for the fine motor and gross motor tasks. Fine motor coordination - Reliability & Validity comparable to Standard Care @768 kps Gross motor coordination (gait ) – Validity not comparable to Standard Care Still spatial relationships - Reliability & Validity comparable to Standard Care at all of the bandwidths
Teletechnology InfrastructureSecurity HIPPA Full face image and/or Voice = PHI Can’t post cell phone video to U-tube for review Skype isn’t HIPPA compliantCosts Equipment Internet access Who pays?
CCNC Informatics Center Information Support for Patient-Centered Care Develop a better healthcare system for NC starting with public payers Strong primary care is foundational to a high performing healthcare system Additional resources needed to help primary care manage populations Must build better local healthcare systems ( public-private partnership). Community Care is a clinical partnership, not a regulatory management agency. Physician leadership is critical. Providers who are expected to improve care must have ownership of the improvement process Achieve savings through better quality and efficiency of care Timely data is essential to success
HC Data for Population Mgmt and QI1. Identification of High-Risk/ High-Opportunity Patients for Targeted Services (Examples: Identification of individuals with above-expected preventable utilization, Hypertension Self- Management Support)2. Cost/utilization performance measurement coupled with actionable information (Examples: Pharmacy Initiatives, In- patient and ED Reporting)3. Quality Measurement and Feedback coupled with actionable information (Examples: Practice Views with County, Network, and State Benchmarks; i.e., % eye exams for diabetes patients)
ID of Patients for Case Mgmt Historically, case management efforts have = Historical or predicted costs for an individual been targeted at the highest utilizers $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20KCRG#1 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K Expected potentially preventable costsCRG#2 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K Priority patients for care managementCRG#3 $0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
NCB PreparedA Public/Private Consortium (UNC, NCSU, SAS, DHS) focused onbio-surveillance – accurately detect and rapidly analyze biologicalhazards to ensure public health and safety. • Improve early recognition of outbreaks augmenting bio- surveillance • Improve situational awareness • Faster and more accurate information for decision makers • Integration with emergency management and law enforcement
Data ValuePROCESSGet DataUse AnalyticsProvide InformationCLIENT OPPORTUNITIES (?) Food Pharma Finance Pub Health EMS News
Focus on NC – Recurring Themes Government (US & NC) Funding Fundamental Change tied to Technology Big Data used predictively not reflexively Improve patient care Security Cost Models Opportunities!